A 2016 lifestyle report published in Medscape shows a correlation between a doctor’s biases toward groups of patients and feelings of stress. Further, 2016’s survey echoed earlier reports that suggest that physician burnout is reaching critical levels in the U.S. In these surveys, “burnout” is defined as “loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.”
Not surprisingly, the report shows that physicians in critical care and emergency services take the top positions in the burnout rating (55% each) while the lowest doctors reporting burnout are in psychiatry and mental health (40%) and ophthalmology (41%). What struck me in looking at this graph is that the spread between the highest and lowest physician groups reporting burnout is rather small at 17%, with most specialties residing near the 50% mark, meaning that nearly half of every doctor respondent reported feelings of burnout.
The respondents in the survey were asked to rate their burnout on a scale of 1 to 7. An answer of 1 indicates that burnout “does not interfere with my life” while 7 indicates that burnout “is so severe that I am thinking of leaving medicine altogether.” Most specialities again found the mean at just over 4, the highest being critical care (4.75) and the lowest being psychiatry and mental health (3.85).
More female doctors experience burnout than their male counterparts (55% to 46% in 2016), but it is interesting to note that the spread between the two (~8-11%) has remained fairly constant while both numbers are trending higher, increasing a whopping 10% in just 3 years (up from 45% and 37% in 2013).
So, we know that physicians are getting more burnt-out over time, and we can look at the main causes of physician burnout (bureaucracy, long hours, technology compliance, income), but what is interesting is the direct correlation between higher admissions of biases toward groups of patients with increased burnout.
A bias in this case is a preconceived notion about a group or set of patients before said patient comes in contact with the respondent. Naturally, some of those biases are fairly easy to identify by simply looking at the patient (race, age, gender, etc.) and those were reported far less as a bias than other more abstract descriptions (emotional problems, intelligence, insurance coverage or lack thereof).
Perhaps unsurprisingly, biases tended to occur more in specialties where physicians and doctors had the most direct contact with patients (Emergency, Orthopedics, Psychiatry, etc.) as compared to specialties with little interaction between patient and doctor (Pathology, Radiology, Cardiology). In certain fields, biases reportedly affected treatment by as much as 14% (Emergency Medicine), but had very little to no influence in fields where the doctor and patient have low interaction (Pathology at 1% , Radiology at 2%).
There are many more slides in this detailed report, but pay special attention to this one, which illustrates that physician burnout is directly linked to bias. Of burnt-out physicians, 43 percent reported having biases, while 57 percent reported no biases. Contrast that to the group of non-burnt-out physician, of which only 36 percent reported biases while 64 percent did not.
And while this report suggests that burnout is increasing for doctors overall, and that there is some correlation between bias and stress, there are some positive takeaways. I think it’s fair to argue that society’s most deeply entrenched biases, both implicit and explicit, are rooted in easily identifiable contrasts, such as race, gender, attractiveness, and age, attributes which are core to the individual and the person holding the bias. The good news is that these types of biases were reported far less than more nebulous biases such as a patient’s intelligence, emotional problems, language difference, and weight.
In fact, many of these more nebulous biases can potentially be fixed right then and there. In the case of a language barrier, for instance, a hospital can implement protocols to make translators available for the most commonly spoken languages in the area. In the case of worrying about a patient’s potential emotional problems (a very broad category, ranging from drug-seeking behavior, noncompliance, refusal to cooperate, to malingering) many of these issues can be mitigated by coordinating with social outreach programs, social workers, and other personal counselors. Some physicians reported that sufferers of chronic pain could evoke bias in doctors, which isn’t necessarily a bad thing—for some pain sufferers, the line between effective pain management and drug-seeking is a very thin one indeed, one that can get blurred over time, and bias against drug-seeking behavior on a physician’s part may, in fact, help the patient.
By doing whatever it takes to eliminate or to at least mitigate our implicit and explicit biases with the help of staff, counselors, and translators, physicians can actually increase their longevity in the medical industry by staving off burnout. Biases, in general, may never go away, both in medicine and society at large, but it appears clear from this study that biases breed negativity, which leads to higher levels of stress. When you add that extra stress to the increasing burden of the American doctor, already under pressure from longer hours, bureaucratic tasks, increased computerization of the medical records, and compassion fatigue, you get the feeling that biases could be the last straw.
As always, we here at PracticeProtection strive help our doctors anyway we can by providing affordable, comprehensive, and customized policies tailored to your specific needs. We are the “by doctors, for doctors” insurance carrier, so we know first-hand the great deal of stress today’s physician encounters. Make sure your insurance carrier isn’t adding to your already high level of stress. Give us a call, or click here for a free online no-hassle quote to see how we can help shoulder some of the burden.